What is Sheehan's Syndrome?

Although Stacey's first delivery was uneventful, she experienced severe blood loss during the birth of her second child. A few months later, a specialist diagnosed her as suffering from Sheehan's syndrome.

What is Sheehan's Syndrome?

This condition occurs among women who bleed severely during or after childbirth, according to MedlinePlus. When this degree of bleeding occurs, it can deprive a woman's body of oxygen, causing serious damage to important tissues and organs.

Sheehan's syndrome damages the pituitary gland. As a result, the body permanently produces a substandard level of essential pituitary hormones. The Mayo Clinic indicates that the resulting condition is known as hypopituitarism.

Although there are several theories on what causes the severe blood loss resulting in this disorder, experts really aren't sure why it happens. Risk factors for developing the condition include being pregnant with multiples or having an abnormality associated with the placenta. The disorder is considered very rare in industrialized countries but a major health threat in others.

Signs and Symptoms

Some women with Sheehan's syndrome experience few symptoms. In others, the disorder creates a life-threatening adrenal crisis because of a shortage of cortisol, a very powerful stress hormone. Sometimes symptoms don't appear until several years after the delivery.

Patients can have difficulty breast feeding. Some are unable to do so because they don't produce any breast milk. Many experience fatigue, weight loss or low blood pressure. Other signs include infrequent menstrual periods or the absence of them.

In some cases, patients report slowed mental function, trouble staying warm and gaining weight - all due to an underactive thyroid gland. Many patients experience loss of body hair in certain areas.

For women who live symptom-free for years with pituitary insufficiency, a diagnosis of Sheehan's syndrome occurs when they move into an adrenal crisis caused by physical stress like surgery or a significant infection.

Diagnosis and Treatment

Doctors diagnose Sheehan's syndrome based on a patient's medical history and symptoms. If either one points toward a pituitary insufficiency, blood tests can check the levels of pituitary hormone.

Some patients require imaging such as an MRI or CT scan to measure the size of the pituitary gland. These scans also look for other potential causes of the symptoms, such as a pituitary tumor.

Health care providers treat Sheehan's syndrome using hormone replacement therapy for the life of the affected individual. The medications typically selected include:

Corticosteroids. The prescription might be for hydrocortisone or prednisone. These medications replace adrenal hormones the body isn't manufacturing. The dosage must be adjusted during periods of serious illness or major physical stress since the normal human body produces extra cortisol under those circumstances. Experiencing illnesses like the flu and procedures such as surgery or dental care require adjusting the dose. So can a significant weight gain or loss, as well as becoming pregnant.

Levothyroxine. Two common brands are Levoxyl and Synthroid. This type of drug elevates low thyroid hormone levels resulting from low or deficient thyroid-stimulating hormone (TSH) production associated with Sheehan's syndrome.

Estrogen. Women who've had a hysterectomy usually receive estrogen by itself. Those who still have a uterus typically receive a combination of estrogen and progesterone. These medications are available in both pill and patch form. For women who've become infertile, doctors can inject drugs known as gonadotropins to stimulate ovulation.

Growth hormone. Certain research suggests that when doctors replace growth hormone in women with Sheehan's syndrome, the substance can help normalize patients' weight, lower cholesterol levels and generally improve the quality of life.

An endocrinologist is the specialist most likely to treat patients with this disorder. Treatment also includes blood tests at regular intervals to make sure women receive sufficient but not excessive amounts of any hormones prescribed. This usually means checking levels every few weeks or months at the beginning of treatment, then just once a year. With early diagnosis and treatment, the prognosis for patients with Sheehan's syndrome is excellent.

Sources:

http://www.nlm.nih.gov/medlineplus/ency/article/001175.htm

http://www.mayoclinic.com/health/sheehans-syndrome/DS00889